| NPI | 1013758044 |
|---|---|
| Former Legal Business Name | N/A |
| Entity Type | Organization |
| Authorized Contact | ABIOSE ADEBOYE Pmhnp 346-652-6822 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2024-06-04 |
| Last Update Date | 2024-08-18 |